Category: Home Health Reimbursement

2019 Rural Add-On Changes

By Melinda Gaboury / Posted on: November 30, 2018 3 minutes to read

As if the changes in the payment system were not enough. Based on the 2019 Medicare Home Health Final Rule, released in early November 2018, the Rural Add-On is being completely revised.

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2019 Value Based Purchasing Proposed Changes

By Melinda Gaboury / Posted on: August 27, 2018 5 minutes to read

CMS released the CY2019 Medicare Home Health payment rule July 12, 2018. A large part of the proposed changes are to the Value-Based Purchasing (VBP) Model. One of the agency’s proposed refinements of VBP is removing five measures while adding two new proposed composite measures.

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2019 Home Health Proposed Payment Rule – PDGM 2020

By Melinda Gaboury / Posted on: August 8, 2018 9 minutes to read

The Centers for Medicare and Medicaid Service (CMS) released the CY2019 Medicare Home Health payment rule July 12, 2018. This proposed rule is voluminous and carries an immense number of proposed changes. HPS will continue analyzing and updating the proposed elements of this rule.

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Pre-Claim Review Demonstration Coming Back?

By Melinda Gaboury / Posted on: June 7, 2018 4 minutes to read

CMS released a Comment Request, via the Federal Register, regarding Pre-Claim Review Demonstration being set to return on or after October 2018 in Illinois, Ohio, North Carolina, Florida, and Texas. The revised demonstration would last five years and Illinois will kick off the demonstration again and will be followed by Ohio and North Carolina and later Texas and Florida.

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Targeted Probe and Educate – What We Have Learned So Far

By Melinda Gaboury / Posted on: March 13, 2018 7 minutes to read

Targeted Probe & Educate began on 10/1/17 and is full speed ahead. HPS has discovered nuances with TPE that we did not expect nor have we experienced in past ADR reviews. This review includes targeted medical review and education along with the potential of elevated action toward the agency. This elevated action could take place if the agency is not meeting the standards laid out by the Medicare MAC.

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Home Health & Hospice PEPPER Reports

By Melinda Gaboury / Posted on: January 15, 2018 7 minutes to read

Over the past couple of years, HPS has reported and discussed that Home Health and Hospice PEPPER Reports are very important and should be reviewed by all agencies. We have also been open about the number of agencies in the country that have never opened the reports. HPS is happy to report that, for the 8 months ending December 20, 2017, 58.5% of all hospices have opened their reports. Only 5 states and 1 territory are below 50%. The sad news is that home care…

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New Medicare Beneficiary Identifiers

By Melinda Gaboury / Posted on: December 20, 2017 4 minutes to read

HPS has given you a couple of updates on the new Medicare Beneficiary Identifier (MBI) cards over the past few months and we continue that update today. Following are more questions answered about the new Medicare numbers and how that will affect your agency. Key dates to remember: April 1, 2018 – Patients will begin to receive new Medicare cards and agencies should begin the process of asking…

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2018 Home Health Final Rule

By Melinda Gaboury / Posted on: November 14, 2017 8 minutes to read

The Breaking News that has every one full of excitement and hope is that the 2018 Home Health Final Rule does NOT include finalizing HHGM, at this time, which was set for implementation in 2019! The battle has been won, BUT the war has just begun! Some form of payment reform will occur in home health. It is not…

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Claim Denials Due to NO OASIS Will Now Return to Provider

By Melinda Gaboury / Posted on: October 23, 2017 6 minutes to read

The claim edit that has been in place since April 3, 2017 has been denying home health claims, at the point of billing, if the matching OASIS was not in the ASAP database. Some of these denials have been the result of data not matching between the claim and the OASIS, primarily the patient’s HIC number being different or the OASIS…

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New Medicare Cards – Questions Answered

By Melinda Gaboury / Posted on: October 10, 2017 6 minutes to read

HPS reported on the coming changes to the Medicare cards a few months ago. Today we offer more answers as have been gathered from CMS via the Medicare Learning Network page of the CMS site. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires the removal…

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Targeted Probe and Educate

By Melinda Gaboury / Posted on: September 25, 2017 5 minutes to read

HPS reported recently regarding continued Probe & Educate for Home Health agencies. This is to clarify that the CMS expansion on Probe & Educate is for Home Health and Hospice and will be effective 10/1/2017. This is referred to as Targeted Probe & Educate (TPE). This review will include targeted medical review and education along with an option for potential elevated action, up to and including referral to other Medicare contractors including the Zone Program Integrity Contractor (ZPIC), Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), etc.

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2018 Home Health Proposed Payment Rule – Including Intro to HHGM

By Melinda Gaboury / Posted on: July 31, 2017 13–15 minutes to read

The Centers for Medicare and Medicaid Service (CMS) released the CY2018 Medicare Home Health payment rule last week. This proposed rule is voluminous and carries an immense number of proposed changes.  HPS will continue analyzing and updating on the proposed elements of this rule.

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Delayed Implementation of Home Health CoPs

By Melinda Gaboury / Posted on: July 14, 2017 2 minutes to read

Last week CMS issued a Final Rule that changed the new Home Health CoPs rule implementation date to January 13, 2018. HPS announced the proposed rule a few months ago. NAHC and the Forum of State Associations spearheaded this effort to postpone the rule because of the extensive changes that are…

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Changes Coming to Medicare HIC Numbers – Medicare Beneficiary Identifier

By Aaron Carey / Posted on: June 22, 2017 5 minutes to read

Former President Harry S. Truman was the very first Medicare beneficiary to be issued a Health Insurance Claim Number (HICN) when then President Lyndon B Johnson signed the Medicare program into law on July 30, 1965. Ever since then, Medicare beneficiaries upon entitlement, have been issued a Health Insurance Claim Number (HICN). The primary issuer of the HICN is the social security administration with the railroad retirement Board issuing HIC numbers for railroad workers. Beginning in 2018 the Medicare HIC number will be replaced with a new identifier called a Medicare Beneficiary Identifier (MBI). The MBI numbers will be…

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Home Health PEPPER is HOT!

By Melinda Gaboury / Posted on: May 26, 2017 5 minutes to read

One of the Hot Topics surrounding the medical review contractors and Medicare MACs is Home Health PEPPER (Program for Evaluating Payment Patterns Electronic Report)! Pepper is an accumulation and calculation of certain statistics that result from claims data. These Medicare claims data statistics are calculated for areas that may be at risk for improper Medicare payments such as…

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How To Access The Provider Statistical & Reimbursement Report

By Aaron Carey / Posted on: March 17, 2017 3 minutes to read

It is that time of year again. Cost report season for home health and hospice providers. Cost reports are due five months after your agency fiscal year end. For agencies with a 12/31/16 fiscal year end cost reports are due by 05/31/17.

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HIPAA for Home Care | Establishing A Compliant Agency

By Drew Rowley / Posted on: March 3, 2017 5 minutes to read

HIPAA has become an acronym synonymous with healthcare. We see it practiced and preached daily throughout the home care and hospice industry. However, too often breach notifications are at the top of our industry headlines. These breaches are costing our agencies time, money, and patient credibility. If we as agency owners, administrators, and employees understand the severity of a breach then why are breaches still occurring?

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Are You Thriving?

By Melinda Gaboury / Posted on: January 20, 2017 4 minutes to read

The constant additions of new programs and new methods, updates and consideration of changes is almost unbearable for some agencies.  Home Health has been hit really hard since 2008 and no relief seems to be coming.   Value-Based Purchasing, Pre-Claim Review, New CoPs, OASIS-C2, ICD-10 CM and now possibly major changes to the Prospective Payment System in regard to reimbursement.

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Are you G Code Savvy?

By Melinda Gaboury / Posted on: January 13, 2017 6 minutes to read

Many have not yet realized that there were additional G codes introduced that went into effect January 1, 2017. These codes were not a part of the 2017 Home Health Final Rule, but were introduced in the CR9736 issued November 10, 2016.

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Late NOE Exceptions Clarified

By Melinda Gaboury / Posted on: January 4, 2017 6 minutes to read

Notices of Election (NOE) that are filed and/or accepted at the Medicare Administrative Contractor (MAC) outside of the required 5 calendar day requirement, penalizes the hospice and the hospice does not receive reimbursement for any services until the NOE is accepted at the MAC.  There have been some significant reimbursement issues with hospices due to this requirement, even when the issue was out of the control of the hospice and due to a Medicare system processing issue.

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Search Home Health in the NEAR Future!

By Melinda Gaboury / Posted on: December 21, 2016 5 minutes to read

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NO OASIS Submission Equals NO Payment

By Aaron Carey / Posted on: November 15, 2016 5 minutes to read

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2017 FINAL Home Health Rule

By Melinda Gaboury / Posted on: November 3, 2016 6 minutes to read

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Reimbursement Impact of OASIS-C2

By Melinda Gaboury / Posted on: October 7, 2016 3 minutes to read

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The FOUR Questions!

By Melinda Gaboury / Posted on: September 27, 2016 6 minutes to read

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BREAKING NEWS – PRE-CLAIM REVIEW DELAYED

By Melinda Gaboury / Posted on: September 20, 2016 3 minutes to read

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Proposed VBP Changes 2017

By Liz Landreth / Posted on: July 20, 2016 10–12 minutes to read

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2017 Proposed Home Health Rule

By Melinda Gaboury / Posted on: July 13, 2016 4 minutes to read

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A Bit of Relief with HbA1c Update!

By Liz Landreth / Posted on: May 10, 2016 3 minutes to read

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Can You Afford to Ignore?

By Melinda Gaboury / Posted on: March 11, 2016 6 minutes to read

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Will it Ever End? – Medicare Prior Authorization!

By Melinda Gaboury / Posted on: February 26, 2016 3 minutes to read

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Medicaid and F2F: The Day has Officially Arrived!

By Dedra Briggs / Posted on: February 9, 2016 8 minutes to read

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Value Based Purchasing: What We Weren’t Sure of!

By Melinda Gaboury / Posted on: January 14, 2016 4 minutes to read

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2016 HHRG Tables & Hospice CBSAs!

By Melinda Gaboury / Posted on: December 22, 2015 2 minutes to read

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2016 HHRG Tables & Hospice CBSAs!

By Melinda Gaboury / Posted on: December 22, 2015 2 minutes to read

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Ushering In 2016 – Kick off the Year Right!

By Melinda Gaboury / Posted on: December 11, 2015 5 minutes to read

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2016 Home Health Rates Continued Decline!

By Melinda Gaboury / Posted on: November 13, 2015 3 minutes to read

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The Nervous Nine Have Been Confirmed!

By Melinda Gaboury / Posted on: November 2, 2015 5 minutes to read

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New G-Codes Not JUST for HOSPICE!

By Melinda Gaboury / Posted on: October 23, 2015 5 minutes to read

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The Complexities of Medicare Secondary Payer Billing

By Aaron Carey / Posted on: October 16, 2015 6 minutes to read

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The Y2K of Coding!

By Melinda Gaboury / Posted on: October 5, 2015 5 minutes to read

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Finally Some Relief or Not!

By Melinda Gaboury / Posted on: September 29, 2015 4 minutes to read

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Home Care and Hospice: Still No Relief!

By Melinda Gaboury / Posted on: September 11, 2015 5 minutes to read

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Is Canceling RAPs a Strategy for your Agency?

By Melinda Gaboury / Posted on: August 31, 2015 7 minutes to read

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CMS Issues 2016 FINAL Hospice Rule – Part 2

By Melinda Gaboury / Posted on: August 21, 2015 5 minutes to read

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Are You Overwhelmed by it All?

By Melinda Gaboury / Posted on: July 22, 2015 6 minutes to read

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2016 Proposed Rates Cannot Be Ignored!

By Melinda Gaboury / Posted on: July 15, 2015 5 minutes to read

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The Nervous Nine!

By Melinda Gaboury / Posted on: July 9, 2015 6 minutes to read

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Medicare Web Portals – Navigating the “Dark Days”

By Aaron Carey / Posted on: June 28, 2015 4 minutes to read

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Home Care HIPPS Code Corrections When Re-Coded

By Melinda Gaboury / Posted on: May 27, 2015 5 minutes to read

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Medicare Managed Care – Can it be Managed? (Part Three)

By Aaron Carey / Posted on: April 21, 2015 9 minutes to read

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Medicare Managed Care – Can it be Managed? (Part Two)

By Aaron Carey / Posted on: April 15, 2015 8 minutes to read

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Medicare Managed Care – Can it be Managed?

By Aaron Carey / Posted on: April 6, 2015 5 minutes to read

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Additional Development Request Checklist

By Dedra Briggs / Posted on: March 9, 2015 6 minutes to read

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OASIS to Claim Data Matching

By Aaron Carey / Posted on: February 9, 2015 4 minutes to read

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Home Care Final Rule 2015: Case-Mix & CBSA Changes!

By Melinda Gaboury / Posted on: January 12, 2015 5 minutes to read

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Home Care Final Rule 2015: Case-Mix & CBSA Changes!

By Melinda Gaboury / Posted on: January 12, 2015 5 minutes to read

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